Provider Demographics
NPI:1639770878
Name:PERU, BRIANA MARIE
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:MARIE
Last Name:PERU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 E DEERFIELD RD APT D287
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-4587
Mailing Address - Country:US
Mailing Address - Phone:517-945-1411
Mailing Address - Fax:
Practice Address - Street 1:623 W WARWICK DR STE 2
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1177
Practice Address - Country:US
Practice Address - Phone:989-285-1490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician